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PubMed2006

Evaluation of instrumented shoes for ambulatory assessment of ground reaction forces.

Currently, force plates or pressure sensitive insoles are the standard tools to measure ground reaction forces and centre of pressure data during human gait. Force plates, however, impose constraints on foot placement, and the available pressure sensitive insoles measure only one component of force. In this study, shoes instrumented with two force transducers measuring forces and moments in three dimensions were evaluated. Technical performance was assessed by comparing force measurement and centre of pressure reconstructions of the instrumented shoes against a force plate. The effect of the instrumented shoes on gait was investigated using an optical tracking system and a force plate. Instrumented shoes were compared against normal shoes and weighted shoes. The ground reaction force measured with force plate and instrumented shoes differed by 2.2+/-0.1% in magnitude and by 3.4+/-1.3 degrees in direction. The horizontal components differed by 9.9+/-3.8% in magnitude and 26.9+/-10.0 degrees in direction. Centre of pressure location differed by 13.7+/-2.4mm between measurement systems. A MANOVA repeated measures analysis on data of seven subjects, revealed significant differences in gait pattern between shoe types (p</=0.05). A subsequent univariate analysis showed significant differences only in maximum ground reaction force but these could not be attributed to specific shoe types by pair-wise comparison. This study indicates that shoes instrumented with force transducers can be a valuable alternative to current measurement systems if accurate sensing of position and orientation of the force transducers is improved. They are applicable in ambulatory settings and suitable for inverse dynamics analysis.

Foot↗
PubMed1998

Individual effects on biomechanical variables during landing in tennis shoes with varying midsole density.

The aim of this study was to determine whether individuals responded uniquely to three different pairs of tennis shoes that differed only in midsole hardness. Kinematic and kinetic data were collected while the subjects (n = 3) performed a stereotyped lateral movement wearing each of the three pairs of tennis shoes. The results were analysed statistically for each subject separately. Variables were identified as discriminators between shoes for individual subjects based upon the results of separate discriminant analyses. After these analyses, a multivariate analysis of variance (MANOVA) was used for each subject to determine whether the discriminator variables differed significantly between shoes. A scoring system was devised that used the results of the MANOVA to assign scores to shoes for each variable. Cumulative scores for shoes (for each subject) were compared to determine which shoe was best for a subject. The results indicated that each subject responded uniquely to the shoes, and each demonstrated a preference for a particular pair of shoes. A need for single-subject designs exists when evaluating variations in athletic shoes.

Biomechanical Phenomena↗
PubMed2002

Interaction of wrestling shoe and competition surface: effects on coefficient of friction with implications for injury.

The purpose of this study was to determine whether there is a significant difference in the co-efficient of friction (Fc) between old versus new wrestling shoes and mats and to investigate the effect of perspiration. Fc was measured by dragging a weighted shoe over a wrestling mat surface and measuring the vertical and horizontal forces produced. Three different shoe conditions were assessed over two mat types for both wet and dry conditions for a total of 12 conditions. To simulate the wet condition, saline solution was smeared over the surface of the mat. There was a significant effect of shoe, mat, and wet/dry conditions. In addition, significant interactions of shoe by mat, shoe by dry/wet, and mat by dry/wet were observed. Overall, Fc was 36% higher for the new wrestling mat compared to the old wrestling mat. Application of the saline solution reduced Fc by 14% compared to the dry condition. Comparison of the mean Fc for all three shoe types revealed the Fc for the older design shoe was 23% to 28% lower than the brand new shoe and the worn newer design, respectively. A high Fc, such as in the new mat/new shoe combination, has the potential to increase the risk of knee and ankle injuries by fixing the foot more securely to the ground.

Athletic Injuries↗
PubMed1996

Shoe characteristics and balance in older women.

OBJECTIVE: To determine whether shoe characteristics affect balance in older women. DESIGN: Randomized order, cross-over, controlled comparison. SETTING: A retirement village. PARTICIPANTS: Thirty women aged 60 to 89 years (mean 78.7 SD = 8.5). Twenty-five subjects were hostel residents, and five were living independently in the community. OUTCOME MEASURES: Postural sway, maximal balance range, and co-ordinated stability. MAIN RESULTS: The subjects underwent assessments of static balance (body sway) and dynamic balance (maximal balance range and co-ordinated stability) under four conditions: (1) barefoot, (2) in standard low-heeled shoes (walking shoes), (3) in standard high-heeled shoes, and (4) in their own shoes. Manova analysis revealed a significant overall shoe condition effect -- subjects performed best in bare feet or low-heeled shoes and worst in high-heeled shoes. There were no significant differences between subjects with and without foot abnormalities in any of the balance measures or test conditions. CONCLUSION: These findings suggest that bare feet and walking shoes maximize balance, whereas high-heeled shoes constitute a needless balance hazard for older women.

Aged↗
PubMed1999

Effects of shoe collar height and sole hardness on balance in older women.

OBJECTIVE: To determine whether shoe collar height and sole hardness affect balance in older women. DESIGN: A randomized order, cross-over, controlled comparison. SETTING: Intermediate care institution and regional hospital. PARTICIPANTS: Forty-two women aged 60 to 92 years (mean 76, SD = 9.03). The sample comprised 15 hostel (intermediate care) residents, 11 women who lived in a retirement village, and 16 women who lived independently in the community. OUTCOME MEASURES: Postural sway, maximal balance range and coordinated stability. MAIN RESULTS: The subjects underwent assessments of static balance (body sway) and dynamic balance (maximal balance range and coordinated stability) under five conditions: (1) in soft-soled bowls shoes, (2) in hard-soled bowls shoes, (3) in college-style shoes, (4) in college-style shoes with a high (boot) collar, and (5) barefoot. MANOVA analysis indicated that subjects were more stable when wearing the high collar shoes than when wearing the college shoes (P < .001) or when barefoot (P < .05). In contrast, subjects performed similarly in the balance tests in the soft and hard-soled shoes (P = .30) and no better than when barefoot (P = .12 and P = .93, respectively). CONCLUSIONS: The findings indicate that subjects had better balance when wearing shoes with high collars than when wearing shoes with low collars and that sole hardness was not related to balance.

Accidental Falls↗
PubMed1992

The art and science of fitting shoes.

The two primary components of achieving proper shoe fit are shoe shape and shoe size. Shoe shape refers to the shape of both the sole and the upper. Proper fit is achieved when shoe shape is matched to foot shape. Shoe size is determined by arch length rather than overall foot length. The proper shoe size is the one that accommodates the first metatarsal joint in the widest part of the shoe. A set of seven guidelines for achieving proper shoe fit is offered. Properly fitting shoes are important in avoiding foot discomfort and deformity, and are absolutely essential in patients with arthritis, diabetes, and other foot disorders.

Humans↗
PubMed2004

A systematic review of the methodological quality and extent to which evaluation studies measure the usability of orthopaedic shoes.

OBJECTIVE: To determine the methodological quality of studies evaluating orthopaedic shoes and orthopaedic shoe provisions. To what extent do studies evaluating orthopaedic shoes prescribed for patients with degenerative disorders of the foot, rheumatoid arthritis, diabetes mellitus and neurological foot disorders, focus on the aspects of the International Organization for Standardization (ISO) definition of usability, i.e., effectiveness, efficiency, satisfaction, and context of use? DESIGN: Systematic review. METHODS: A systematic literature search was performed to identify randomized controlled trials (RCTs) concerning orthopaedic shoes and orthopaedic shoe inserts. The methodological quality of the studies was assessed independently by two raters, based on the 19 items of the 'Maastricht-Amsterdam criteria list'. The studies were assessed against the parameters of the ISO definition of usability. RESULTS: Eleven RCTs were included. The methodological scores ranged from 8 to 14 out of 19 possible points. Eleven studies focused on the effectiveness of the orthopaedic shoes and orthopaedic shoe inserts, two of which reported outcome measures and conclusions related to the efficiency of the studied orthopaedic shoes and orthopaedic shoe inserts. Four studies reported some form of patient satisfaction and only three studies paid attention to the context of use. CONCLUSIONS: The methodological quality of the RCTs as assessed according to the 19 different criteria varied considerably. The present review shows that current scientific literature concerning the usability of orthopaedic shoes focuses mainly on effectiveness at the expense of the other domains of usability, i.e., efficiency, satisfaction and context of use.

Evaluation Studies as Topic↗
PubMed2005

Use of gyroscopic sensors for objective evaluation of trimming and shoeing to alter time between heel and toe lift-off at end of the stance phase in horses walking and trotting on a treadmill.

OBJECTIVE: To determine whether a shoe with an axialcontoured lateral branch would induce greater lateral roll of the forelimb hoof during the time between heel and toe lift-off at end of the stance phase (breakover). Animals-10 adult horses. PROCEDURE: A gyroscopic transducer was placed on the hoof of the right forelimb and connected to a transmitter. Data on hoof angular velocity were collected as each horse walked and trotted on a treadmill before (treatment 1, no trim-no shoe) and after 2 treatments by a farrier (treatment 2, trim-standard shoe; and treatment 3, trim-contoured shoe). Data were converted to hoof angles by mathematical integration. Breakover duration was divided into 4 segments, and hoof angles in 3 planes (pitch, roll, and yaw) were calculated at the end of each segment. Multivariable ANOVA was performed to detect differences among treatments and gaits. RESULTS: Trimming and shoeing with a shoe with contoured lateral branches induced greater mean lateral roll to the hoof of 3.2 degrees and 2.5 degrees during the first half of breakover when trotting, compared with values for no trim-no shoe and trim-standard shoe, respectively. This effect dissipated during the second half of breakover. When horses walked, lateral roll during breakover was not significantly enhanced by use of this shoe. CONCLUSIONS AND CLINICAL RELEVANCE: A shoe with an axial-contoured lateral branch induced greater lateral roll during breakover in trotting horses, but change in orientation of the hoof was small and limited to the first half of breakover.

Analysis of Variance↗
PubMed2006

Shoeing sound warmblood horses with a rolled toe optimises hoof-unrollment and lowers peak loading during breakover.

REASONS FOR PERFORMING STUDY: Overload injuries in sport horses commonly occur; shoeing techniques are believed to be important in prevention of these injuries, but there is a paucity of scientific information identifying the potential connection. OBJECTIVES: To test a horseshoe with a modified rolled toe designed to ease the process of breakover and decrease loading of lesion-prone structures of the distal limb. METHODS: Twenty clinically sound Warmblood horses trotted over a track containing a pressure/force measuring system and 6 infrared cameras. The horses were measured with 2 types of shoes, standard flat shoes and shoes with a rolled toe. The shoeing procedure was randomised and horses had 2 days between measurements to adapt to the shoes. RESULTS: Limb placement and timing characteristics, e.g. breakover duration, did not change significantly. There was an improvement in the ease of movement to roll over the toe in the shoes with a rolled toe, due mainly to a smoother hoof-unrollment pattern. The peak indicative moment decreased substantially at the onset of breakover in the shoe with the rolled toe. CONCLUSIONS: With a rolled toe the process of hoof-unrollment is smoother, which improves the coordination of this process, and lowers peak loading of the distal limb during breakover. POTENTIAL RELEVANCE: This study stresses the importance of proper shoeing in sound horses, showing that shoe modifications can optimise the loading characteristics of the distal limb and therefore might be a means to prevent sport horses from overload injuries.

Animals↗
PubMed1999

Patient compliance and effect of orthopaedic shoes.

Orthopaedic shoes are individually handmade after a prescription from an orthopaedic surgeon, hence relatively expensive. Bad compliance is mentioned in the literature but not investigated. In order to evaluate patient compliance and the effect of orthopaedic shoes, 85 patients who were prescribed orthopaedic shoes at the authors' department during a 3 year period received a questionnaire concerning relief of symptoms and daily use of the shoes. The answers from 74 patients were correlated to the prescription procedure and the degree of medical follow-up. Only 60 of 74 patients used their shoes. Some 51 patients had some benefit while 23 had no effect or even worse symptoms. Some patients even used their shoes despite no symptomatic relief. However, patients who felt they were well informed about the purpose and function of their shoes had more benefit than the rest. Only 12 patients of the 74 were checked by the orthopaedic surgeon after delivery of the shoes. In conclusion the authors believe there is a great need for information to be given to the patients about the functions and limitations of orthopaedic shoes and that every patient should be offered a control check-up by the surgeon. Further investigations of the effect of orthopaedic shoes should be carried out to optimise the use of these expensive devices.

Aged↗
PubMed1991

The effects of shoes on the torsion and rearfoot motion in running.

Excessive pronation is accepted as a good indicator for various running injuries. The least amount of pronation takes place when running barefoot. The latest investigations show that this is connected to a large torsional movement between forefoot and rearfoot which can be influenced by the shoe sole construction. The shoes which are in use among runners in track and field are basically of two types, running shoes (in general torsionally stiff) and spikes (torsionally flexible). The possibly varying effect of these shoes on the shoe/foot motion in running is not known. The purpose of this investigation was therefore to show whether the pronation angle and the torsion angle differ when running barefoot, with spikes, and with running shoes (forefoot touchdown, N = 9 left and right). A film analysis provided the angular movements of the lower leg, rearfoot, and forefoot as well as pronation and torsion in the frontal plane. The results show that at touchdown the torsional movements with both shoe types are quite different from those of running barefoot. With shoes, the torsion angle is reduced back to zero--with running shoes more than with spikes--and the pronation angle is increased beyond the barefoot values (P less than 0.01). In order to reduce the risk of injury, both shoe types should be improved--the running shoes with respect to torsion and the spikes with respect to pronation.

Achilles Tendon↗
PubMed1980

Corrective shoes for children: a survey of current practice.

A survey of shoe-prescribing practices for children was taken among pediatricians, orthopaedists, pediatric orthopaedists, and podiatrists. Opinions differed significantly regarding the usefulness of shoe modifications for common pediatric lower limb and foot problems. Parents' attitudes toward children's shoes were also surveyed. Pediatricians and pediatric orthopaedists tended to prescribe corrective shoes less often than did orthopaedists and podiatrists. High topped shoes are not necessary to promote normal foot development, in the opinion of 85% of those surveyed; however, high topped shoes were often recommended for infants because they slip off less easily. Preferences for Thomas heels, scaphoid pads, reverse lasts, straight lasts, wedges, torque heels, and shoe lifts for problems including flexible flat feet, metatarsus adductus, intoeing, bow legs, knock knees, and leg length inequalities were delineated among the four groups treating children's feet. The authors conclude that whereas studies show that shoe modifications are of questionable value in the problems discussed, corrective shoes are often prescribed when regular shoes would be more appropriate and economical.

Attitude↗
PubMed1996

Biomechanical effects of rocker-toed shoes in sound horses.

In many Western European countries rocker-toed shoes are applied routinely in sound horses. This is in contrast to most Anglo-Saxon countries where rocker-toed shoes are used almost exclusively for corrective or orthopaedic shoeing. The purposes of rocker-toed shoes are to hasten or facilitate breakover, or to encourage breakover to occur at the centre of the toe. This study compares the biomechanical effects of rocker-toed shoes with standard flat shoes in twelve sound Dutch warmblood horses, using a modified CODA-3 gait analysis system and a force plate. The variables analysed were speed of breakover, the moment of force in the coffin joint which is related to the 'ease' of breakover, the flight arc of the hoof in the sagittal and horizontal planes and some more general linear, temporal and angular stride characteristics. No differences between rocker-toed shoes and standard flat shoes were found with respect to the duration or ease of breakover or the proximity of breakover to the centre of the toe. It is concluded that rocker-toed shoes do not influence the stride characteristics of sound Dutch warmblood horses, and the findings of this study showed no objective grounds for the use of rocker-toed shoes in sound horses.

Animals↗
PubMed1998

Running shoes for relief of plantar pressure in diabetic patients.

There is a causal relationship between diabetic foot ulceration, elevated plantar pressure, and severe sensory neuropathy. Cushioned footwear intended to relieve plantar pressure is well established for prevention and healing of plantar ulcers. The aim of the present study was to investigate whether pressure relief by means of a running shoe with optimized forefoot pressure damping is comparable to that of a custom-made soft insole placed into an in-depth shoe. The in-shoe pressures were compared to an in-depth shoe with the original cork insole and with a leather-soled Oxford shoe. The maximum reduction of plantar pressure in the running shoe was 47% under the 2nd and 3rd metatarsal heads, 29% at the first metatarsal head, and 32% at the great toe in comparison to the Oxford shoe. This was surpassed only by the custom-made insole, which reduced pressures at the metatarsal heads by 50%. The specially designed running shoe yielded the same pressure relief at the central metatarsal heads as the custom-made insole. Such shoes are likely to be very useful in preventing diabetic foot ulceration in high-risk patients as a comparatively affordable and immediately available device.

Diabetic Foot↗
PubMed1993

The energetics of running and running shoes.

It has been suggested that elastic energy storage and recovery in the cushioning system of an athletic shoe ('energy return') is a desirable quality that can enhance performance. However, comparing the energetics of a running shoe cushioning system with other passive energy exchange mechanisms in the running athlete suggests that the potential benefits of energy return are limited. The energetics of running shoe cushioning systems have been studied using a multiple-element, non-linear viscoelastic model to analyse the effect on the shoe of plantar pressure distributions recorded in vivo. The running shoe is a net dissipator of energy but small quantities of strain energy, of the order of 10J, are stored and recovered during a running step. The actual energy exchanges depend on the cushioning material properties and the runner's plantar pressure distribution. Energy storage and recovery occurs throughout the step in different regions of the shoe midsole. Energy dissipation is confined almost entirely, both spatially and temporally, to the impact phase of ground contact. Thus the proportion of input energy recovered from the shoe is higher than that predicted by mechanical tests which stimulate only the impact phase of the step. Energy storage and recovery in the model shoe are large enough to have local effects on the energetics of the foot and lower leg but modest when compared with passive energy transfer within and between body segments or strain energy storage and recovery in the lower limb. Similarly, differences in the energy dissipated by well-designed shoes are predicted to be small and unlikely to have a direct effect on the energetics of the body as a whole. The possibility of indirect, kinematically mediated effects remains open, however.

Biomechanical Phenomena↗
PubMed2004

Indoor and outdoor concentrations of RSP, NO2 and selected volatile organic compounds at 32 shoe stalls located near busy roadways in Seoul, Korea.

It is suspected that persons who work in indoor environments near busy roadways are exposed to elevated levels of air pollutants during working hours. This study evaluated the potential exposure and source contribution associated with traffic-related air pollution for workers (polishers and repairmen) in shoe stalls from each of 32 districts during working hours in Seoul, Korea. The shoe stalls have been located at very close distances to the busy roadways. In this study, shoe stall workers could be exposed to high levels of respirable suspended particulate (RSP), nitrogen dioxide (NO(2)) and volatile organic compounds (VOCs) from outdoor sources such as traffic exhaust, as well as indoor sources in the shoe stalls such as dust on the shoes, portable gas ranges, organic solvents, adhesives and shoe polish. Compounds of particular note included indoor mean concentrations of benzene, toluene, m/p-xylene and o-xylene were 0.732, 6.777, 4.080 and 1.302 mg/m(3), respectively, in all shoe stalls. Mean indoor/outdoor ratios for toluene and m/p-xylene concentrations were 54.52 and 20.84, respectively. The contribution of vehicle exhaust emissions to indoor air quality of shoe stalls was identified by means of correlating the relationships between simultaneously measured air pollutant concentrations indoors and outdoors. Unlike RSP and NO(2), indoor VOCs concentrations of shoe stalls mainly originated from indoor sources vs. outdoor sources.

Air Pollutants↗
PubMed2000

A comparison of vertical force and temporal parameters produced by an in-shoe pressure measuring system and a force platform.

OBJECTIVE: To investigate the ability of Pedar in-shoe system to measure vertical force accurately, by comparing it with the Kistler force platform. DESIGN: In vivo experiment in normal subjects. BACKGROUND: It has been suggested Pedar is highly reliable, but absolute accuracy of the system with regard to force measurement has not been comprehensively tested. METHODS: Sampling at 99 Hz, using five healthy subjects, simultaneous data were collected barefoot, and in three types of shoes (Trainers, Oxfords, Slip-on Deck Type). Six variables obtained from the force/time curve from each footstep were compared. RESULTS: The temporal data recorded by Pedar correlated well with that obtained using Kistler, with significant differences only in overall duration of the step in Deck shoes (P<0. 001) and Oxford shoes (P<0.01), and peak to peak barefoot (P<0.01). Pedar recorded a lower first peak force and mid-peak force in all cases (P<0.001). However, the magnitude of the 2nd peak force recorded by both systems was significantly different only in Trainers (P<0.05) and Oxford shoes (P<0.001). The impulse data obtained with Oxford shoes was not significantly different, although barefoot, Trainers and Deck shoes were significantly lower (P<0.001) for Pedar. CONCLUSIONS: In most cases, comparison of data recorded by the two systems provided good evidence for the accuracy and reliability of temporal measurements and second peak force measurements taken with the Pedar in-shoe system. Relevance In-shoe pressure data provides evidence for clinical decisions if the systems utilised are proven to be valid, repeatable and accurate. Comparison with an established force platform enables some assessment of these factors.

Adult↗
PubMed2001

A comparison of vertical force and temporal parameters produced by an in-shoe pressure measuring system and a force platform.

OBJECTIVE: To investigate the ability of Pedar in-shoe system to measure vertical force accurately, by comparing it with the Kistler force platform. DESIGN: In vivo experiment in normal subjects. BACKGROUND: It has been suggested Pedar is highly reliable, but absolute accuracy of the system with regard to force measurement has not been comprehensively tested. METHODS: Sampling at 99 Hz, using five healthy subjects, simultaneous data were collected barefoot, and in three types of shoes (Trainers, Oxfords, Slip-on Deck Type). Six variables obtained from the force/time curve from each footstep were compared. RESULTS: The temporal data recorded by Pedar correlated well with that obtained using Kistler, with significant differences only in overall duration of the step in Deck shoes (P < 0.001) and Oxford shoes (P < 0.01), and peak to peak barefoot (P < 0.01). Pedar recorded a lower first peak force and mid-peak force in all cases (P < 0.001). However, the magnitude of the 2nd peak force recorded by both systems was significantly different only in Trainers (P < 0.05) and Oxford shoes (P < 0.001). The impulse data obtained with Oxford shoes was not significantly different, although barefoot, Trainers and Deck shoes were significantly lower (P < 0.001) for Pedar. CONCLUSIONS: In most cases, comparison of data recorded by the two systems provided good evidence for the accuracy and reliability of temporal measurements and second peak force measurements taken with the Pedar in-shoe system. Relevance. In-shoe pressure data provides evidence for clinical decisions if the systems utilised are proven to be valid, repeatable and accurate. Comparison with an established force platform enables some assessment of these factors.

Adult↗